|
HC HEEL NEW LEATHER
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT L3455
|
| Hospital Charge Code |
905353455
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.58 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.26
|
| Rate for Payer: Blue Distinction Transplant |
$48.00
|
| Rate for Payer: Blue Shield of California Commercial |
$60.00
|
| Rate for Payer: Blue Shield of California EPN |
$43.52
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.00
|
| Rate for Payer: Dignity Health Media |
$68.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$60.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$40.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Riverside University Health System MISP |
$32.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.00
|
| Rate for Payer: United Healthcare All Other HMO |
$40.00
|
| Rate for Payer: United Healthcare HMO Rider |
$40.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.00
|
| Rate for Payer: Vantage Medical Group Senior |
$68.00
|
|
|
HC HEEL NEW LEATHER
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT L3455
|
| Hospital Charge Code |
905353455
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Blue Shield of California EPN |
$42.72
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$40.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.21
|
| Rate for Payer: United Healthcare All Other HMO |
$29.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.40
|
|
|
HC HEEL NEW RUBBER
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT L3460
|
| Hospital Charge Code |
905353460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.79 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.36
|
| Rate for Payer: Blue Distinction Transplant |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$52.50
|
| Rate for Payer: Blue Shield of California EPN |
$38.08
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Media |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$52.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$35.00
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.00
|
| Rate for Payer: United Healthcare All Other HMO |
$35.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC HEEL NEW RUBBER
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT L3460
|
| Hospital Charge Code |
905353460
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$49.00
|
| Rate for Payer: Cigna of CA PPO |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$35.00
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.43
|
| Rate for Payer: United Healthcare All Other HMO |
$25.82
|
| Rate for Payer: United Healthcare HMO Rider |
$25.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.10
|
|
|
HC HEEL PAD FOR SPUR
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT L3480
|
| Hospital Charge Code |
905353480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Blue Shield of California EPN |
$65.15
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.07
|
| Rate for Payer: United Healthcare All Other HMO |
$44.99
|
| Rate for Payer: United Healthcare HMO Rider |
$44.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.26
|
|
|
HC HEEL PAD FOR SPUR
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT L3480
|
| Hospital Charge Code |
905353480
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.75 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.08
|
| Rate for Payer: Blue Distinction Transplant |
$73.20
|
| Rate for Payer: Blue Shield of California Commercial |
$91.50
|
| Rate for Payer: Blue Shield of California EPN |
$66.37
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Media |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$91.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.02
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Riverside University Health System MISP |
$48.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.00
|
| Rate for Payer: United Healthcare All Other HMO |
$61.00
|
| Rate for Payer: United Healthcare HMO Rider |
$61.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
HC HEEL SACH CUSHION TYPE
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L3450
|
| Hospital Charge Code |
905353450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Blue Shield of California EPN |
$112.14
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.30
|
| Rate for Payer: United Healthcare All Other HMO |
$77.45
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.30
|
|
|
HC HEEL SACH CUSHION TYPE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L3450
|
| Hospital Charge Code |
905353450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.07
|
| Rate for Payer: Blue Distinction Transplant |
$126.00
|
| Rate for Payer: Blue Shield of California Commercial |
$157.50
|
| Rate for Payer: Blue Shield of California EPN |
$114.24
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Media |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$157.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.10
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$105.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC HEEL THOMAS EXTENDED TO BALL
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT L3470
|
| Hospital Charge Code |
905353470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.82 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$103.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.08
|
| Rate for Payer: Blue Distinction Transplant |
$73.20
|
| Rate for Payer: Blue Shield of California Commercial |
$91.50
|
| Rate for Payer: Blue Shield of California EPN |
$66.37
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$103.70
|
| Rate for Payer: Dignity Health Media |
$103.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$103.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$91.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.02
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: Riverside University Health System MISP |
$48.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.00
|
| Rate for Payer: United Healthcare All Other HMO |
$61.00
|
| Rate for Payer: United Healthcare HMO Rider |
$61.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$103.70
|
| Rate for Payer: Vantage Medical Group Senior |
$103.70
|
|
|
HC HEEL THOMAS EXTENDED TO BALL
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT L3470
|
| Hospital Charge Code |
905353470
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Blue Shield of California EPN |
$65.15
|
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: Cigna of CA HMO |
$85.40
|
| Rate for Payer: Cigna of CA PPO |
$85.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$61.00
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$46.07
|
| Rate for Payer: United Healthcare All Other HMO |
$44.99
|
| Rate for Payer: United Healthcare HMO Rider |
$44.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.26
|
|
|
HC HEEL THOMAS WITH WEDGE
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT L3465
|
| Hospital Charge Code |
905353465
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Blue Shield of California EPN |
$64.08
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.31
|
| Rate for Payer: United Healthcare All Other HMO |
$44.26
|
| Rate for Payer: United Healthcare HMO Rider |
$43.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.60
|
|
|
HC HEEL THOMAS WITH WEDGE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT L3465
|
| Hospital Charge Code |
905353465
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.01 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.90
|
| Rate for Payer: Blue Distinction Transplant |
$72.00
|
| Rate for Payer: Blue Shield of California Commercial |
$90.00
|
| Rate for Payer: Blue Shield of California EPN |
$65.28
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$84.00
|
| Rate for Payer: Cigna of CA PPO |
$84.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.00
|
| Rate for Payer: Dignity Health Media |
$102.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$60.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Riverside University Health System MISP |
$48.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.00
|
| Rate for Payer: United Healthcare All Other HMO |
$60.00
|
| Rate for Payer: United Healthcare HMO Rider |
$60.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.00
|
| Rate for Payer: Vantage Medical Group Senior |
$102.00
|
|
|
HC HEEL WEDGE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L3350
|
| Hospital Charge Code |
905353350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Blue Shield of California EPN |
$26.70
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.88
|
| Rate for Payer: United Healthcare All Other HMO |
$18.44
|
| Rate for Payer: United Healthcare HMO Rider |
$18.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.50
|
|
|
HC HEEL WEDGE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L3350
|
| Hospital Charge Code |
905353350
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.54
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.50
|
| Rate for Payer: Blue Shield of California EPN |
$27.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Media |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25.00
|
| Rate for Payer: United Healthcare HMO Rider |
$25.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC HEEL WEDGE SACH
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT L3340
|
| Hospital Charge Code |
905353340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.58 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.44
|
| Rate for Payer: Blue Distinction Transplant |
$102.00
|
| Rate for Payer: Blue Shield of California Commercial |
$127.50
|
| Rate for Payer: Blue Shield of California EPN |
$92.48
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: Dignity Health Media |
$144.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$127.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Riverside University Health System MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other HMO |
$85.00
|
| Rate for Payer: United Healthcare HMO Rider |
$85.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC HEEL WEDGE SACH
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT L3340
|
| Hospital Charge Code |
905353340
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Blue Shield of California EPN |
$90.78
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$119.00
|
| Rate for Payer: Cigna of CA PPO |
$119.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$85.00
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.19
|
| Rate for Payer: United Healthcare All Other HMO |
$62.70
|
| Rate for Payer: United Healthcare HMO Rider |
$61.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.10
|
|
|
HC HELIOX THERAPY PER DAY
|
Facility
|
IP
|
$4,376.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800410
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$875.20 |
| Max. Negotiated Rate |
$3,938.40 |
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,500.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,750.40
|
| Rate for Payer: Galaxy Health WC |
$3,719.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,625.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,938.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,918.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,667.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.20
|
| Rate for Payer: Multiplan Commercial |
$3,282.00
|
| Rate for Payer: Networks By Design Commercial |
$2,844.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,719.60
|
|
|
HC HELIOX THERAPY PER DAY
|
Facility
|
OP
|
$4,376.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900800410
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$3,938.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,657.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,118.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,585.34
|
| Rate for Payer: Blue Distinction Transplant |
$2,625.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,704.37
|
| Rate for Payer: Blue Shield of California EPN |
$2,126.74
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: Cash Price |
$1,969.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,500.80
|
| Rate for Payer: Cigna of CA HMO |
$2,800.64
|
| Rate for Payer: Cigna of CA PPO |
$3,238.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$3,719.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,625.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,938.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,282.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,918.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$3,282.00
|
| Rate for Payer: Networks By Design Commercial |
$2,844.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,719.60
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,625.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,625.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC HELMET SOFT SHELL 2X-SM TAN
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698208
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC HELMET SOFT SHELL 2X-SM TAN
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698208
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.66
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$364.82
|
| Rate for Payer: Blue Shield of California EPN |
$283.62
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC HELMET SOFT SHELL LARGE
|
Facility
|
OP
|
$488.13
|
|
| Hospital Charge Code |
901604758
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.63 |
| Max. Negotiated Rate |
$439.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$296.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$268.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.39
|
| Rate for Payer: Blue Distinction Transplant |
$292.88
|
| Rate for Payer: Blue Shield of California Commercial |
$307.03
|
| Rate for Payer: Blue Shield of California EPN |
$238.70
|
| Rate for Payer: Cash Price |
$219.66
|
| Rate for Payer: Central Health Plan Commercial |
$390.50
|
| Rate for Payer: Cigna of CA HMO |
$312.40
|
| Rate for Payer: Cigna of CA PPO |
$361.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.91
|
| Rate for Payer: Dignity Health Media |
$414.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.25
|
| Rate for Payer: Galaxy Health WC |
$414.91
|
| Rate for Payer: Global Benefits Group Commercial |
$292.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$366.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.63
|
| Rate for Payer: Multiplan Commercial |
$366.10
|
| Rate for Payer: Networks By Design Commercial |
$317.28
|
| Rate for Payer: Prime Health Services Commercial |
$414.91
|
| Rate for Payer: Riverside University Health System MISP |
$195.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.06
|
| Rate for Payer: United Healthcare All Other HMO |
$244.06
|
| Rate for Payer: United Healthcare HMO Rider |
$244.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.91
|
| Rate for Payer: Vantage Medical Group Senior |
$414.91
|
|
|
HC HELMET SOFT SHELL LARGE
|
Facility
|
IP
|
$488.13
|
|
| Hospital Charge Code |
901604758
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.63 |
| Max. Negotiated Rate |
$439.32 |
| Rate for Payer: Cash Price |
$219.66
|
| Rate for Payer: Central Health Plan Commercial |
$390.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.25
|
| Rate for Payer: Galaxy Health WC |
$414.91
|
| Rate for Payer: Global Benefits Group Commercial |
$292.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.63
|
| Rate for Payer: Multiplan Commercial |
$366.10
|
| Rate for Payer: Networks By Design Commercial |
$317.28
|
| Rate for Payer: Prime Health Services Commercial |
$414.91
|
|
|
HC HELMET SOFT SHELL MED, TAN
|
Facility
|
OP
|
$488.13
|
|
| Hospital Charge Code |
901698207
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.63 |
| Max. Negotiated Rate |
$439.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$296.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$268.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.39
|
| Rate for Payer: Blue Distinction Transplant |
$292.88
|
| Rate for Payer: Blue Shield of California Commercial |
$307.03
|
| Rate for Payer: Blue Shield of California EPN |
$238.70
|
| Rate for Payer: Cash Price |
$219.66
|
| Rate for Payer: Central Health Plan Commercial |
$390.50
|
| Rate for Payer: Cigna of CA HMO |
$312.40
|
| Rate for Payer: Cigna of CA PPO |
$361.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.91
|
| Rate for Payer: Dignity Health Media |
$414.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.25
|
| Rate for Payer: Galaxy Health WC |
$414.91
|
| Rate for Payer: Global Benefits Group Commercial |
$292.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$366.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.63
|
| Rate for Payer: Multiplan Commercial |
$366.10
|
| Rate for Payer: Networks By Design Commercial |
$317.28
|
| Rate for Payer: Prime Health Services Commercial |
$414.91
|
| Rate for Payer: Riverside University Health System MISP |
$195.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.06
|
| Rate for Payer: United Healthcare All Other HMO |
$244.06
|
| Rate for Payer: United Healthcare HMO Rider |
$244.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.91
|
| Rate for Payer: Vantage Medical Group Senior |
$414.91
|
|
|
HC HELMET SOFT SHELL MED, TAN
|
Facility
|
IP
|
$488.13
|
|
| Hospital Charge Code |
901698207
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.63 |
| Max. Negotiated Rate |
$439.32 |
| Rate for Payer: Cash Price |
$219.66
|
| Rate for Payer: Central Health Plan Commercial |
$390.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.25
|
| Rate for Payer: Galaxy Health WC |
$414.91
|
| Rate for Payer: Global Benefits Group Commercial |
$292.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.63
|
| Rate for Payer: Multiplan Commercial |
$366.10
|
| Rate for Payer: Networks By Design Commercial |
$317.28
|
| Rate for Payer: Prime Health Services Commercial |
$414.91
|
|
|
HC HELMET SOFT SHELL SMALL,TAN
|
Facility
|
OP
|
$488.13
|
|
| Hospital Charge Code |
901698206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$97.63 |
| Max. Negotiated Rate |
$439.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$296.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$414.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$268.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$268.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$236.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.39
|
| Rate for Payer: Blue Distinction Transplant |
$292.88
|
| Rate for Payer: Blue Shield of California Commercial |
$307.03
|
| Rate for Payer: Blue Shield of California EPN |
$238.70
|
| Rate for Payer: Cash Price |
$219.66
|
| Rate for Payer: Central Health Plan Commercial |
$390.50
|
| Rate for Payer: Cigna of CA HMO |
$312.40
|
| Rate for Payer: Cigna of CA PPO |
$361.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$414.91
|
| Rate for Payer: Dignity Health Media |
$414.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$414.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$195.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.25
|
| Rate for Payer: Galaxy Health WC |
$414.91
|
| Rate for Payer: Global Benefits Group Commercial |
$292.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$439.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$366.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$325.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$185.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.63
|
| Rate for Payer: Multiplan Commercial |
$366.10
|
| Rate for Payer: Networks By Design Commercial |
$317.28
|
| Rate for Payer: Prime Health Services Commercial |
$414.91
|
| Rate for Payer: Riverside University Health System MISP |
$195.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$292.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$292.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.06
|
| Rate for Payer: United Healthcare All Other HMO |
$244.06
|
| Rate for Payer: United Healthcare HMO Rider |
$244.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$414.91
|
| Rate for Payer: Vantage Medical Group Senior |
$414.91
|
|
